[Surgical management of the thumb with intrinsic palsy]

The long term disability resulting from paralysis of the muscle that control the thumb depends largely of the management (surgical and physiotherapic) of these problems that must be considered in the context of functional disability, and so it is possible to consider specific tendon transfers to improve opposition. This work dealt with paralysis of the thenar muscles. It is helpful to treat such a problem to consider restoring of the anteposition, rotation and adduction of the first metacarpal. In paralysis of the abductor pollicis brevis (APB) and opponents pollicis (OP) it is possible to use as a motor transfer the tendon of extensor pollicis brevis (EPB) or extensor indicis proprius (EPB) or occasionally by palmaris longus (PL). When the flexor pollicis brevis is paralysed, transfer of the flexor sublimis ot the third or the ring finger is used as described by Bunnel. When all thenar muscles are paralysed is very important to assess the range of movement of the trapeziometacarpal joint as well as the presence of any contracture of the first web space. The stability of the metacarpophalangeal and interphalangeal joints must be assessed with pinch grip between thumb and index finger. Careful preoperative assessment of remaining function allows accurate diagnosis and thus what tendon transfer is possible and what other procedure are necessary like arthrodesis of the MP joint, opening of the first web, or stabilization of the IP. The management of these problems is difficult and many factors must be taken into consideration like age, aetiology and experience of the surgeon.